gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Fixel-based analysis of language tumour patients with language symptoms enables detailed white matter analysis also in peritumoral tissue

Fixel-basierte Analyse von Sprachtumorpatienten ermöglicht detaillierte Analyse der weißen Masse im peritumoralen Gewebe

Meeting Abstract

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  • presenting/speaker Lucius Fekonja - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Ziqian Wang - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Thomas Picht - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP160

doi: 10.3205/19dgnc497, urn:nbn:de:0183-19dgnc4970

Published: May 8, 2019

© 2019 Fekonja et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: Degeneration of white matter due to tumor growth and edema is a challenge for white matter tractography. Voxel-based analysis only provides an average value of multiple fiber populations within each voxel and does not account for complex fiber architecture. Fixel based analysis on the contrary, allows to analyse fiber density for individual fiber populations within each voxel, so-called Fixels. Here, we address the potential of the novel Fixel-based analysis to provide detailed measures about white matter morphology also within degenerated tumorous brain tissue.

Methods: Fixel-based analysis of within-voxel fiber cross-section (fc) and fiber density (fd) as well as combined measures (fdc) was performed. To account for white matter morphology, we used Fixel-based morphometry to combine within-voxel information and morphology. For this study we included 46 patients with gliomas grade III and IV in the left hemisphere and invasion of the language network as well as 16 healthy control subjects. The patients were sorted into frontal (16), insular (6), parietal (6) and temporal (18) subgroups. Furthermore, to investigate white matter differences between controls and patients, within each bundle, we assigned mentioned p-values to 72 distinct fiber bundles, which have been dissected with automated tract segmentation via machine learning.

Results: Significant reduction in fc, fd and fdc (p<0.05) was observed in peritumoral areas. Attributing p-values to each Fixel with multiple fiber populations allowed for fiber bundle specific conclusions, which were visualized with group template-based streamlines. Based on this analysis, tractography results were obtained in edematous and tumorous regions and assigned to specific fiber bundles where conventional deterministic tensor-based tractography failed.

Conclusion: Fixel-based fiber specific white matter analysis allows for appreciation of fiber bundle integrity and morphology even in tumorous brain tissue. This method allows for a highly detailed inspection of white matter differences between healthy controls and patients in relation to different tumor locations and specific fiber bundles.